Abstract
BackgroundEctopic parathyroid adenomas can occur in numerous anatomic locations. While ectopic parathyroid adenomas can rarely occur in the pharyngeal region, this has not previously been described in the soft palate.Case presentationWe report the first case of ectopic parathyroid adenoma within the soft palate. A 59 year old woman presented with hyperparathyroidism. She remained persistently hyperparathyroid after initial parathyroidectomy. Repeat exploration for a lesion suspicious on PET-CT for an ectopic parathyroid adenoma in the parapharyngeal region was unsuccessful in treating the hyperparathyroidism. An ectopic adenoma in the soft palate was eventually discovered. Removal through a transoral approach was successful in treating the hyperparathyroidism.ConclusionsEctopic parathyroid adenomas can occur in various anatomical locations that may be missed even with the use of the various imaging modalities. The soft palate should be added to the list of possible ectopic locations high in the neck.
Highlights
Ectopic parathyroid adenomas can occur in numerous anatomic locations
Ectopic parathyroid adenomas can occur in various anatomical locations that may be missed even with the use of the various imaging modalities
The soft palate should be added to the list of possible ectopic locations high in the neck
Summary
The existence of ectopic parathyroid tissue remains a significant hurdle in the surgical management of hyperparathyroidism. Ectopic parathyroid glands have been classically described as occurring in numerous anatomic locations anywhere from the angle of the mandible to the mediastinum [4,5,6] Most commonly they occur in the mediastinum, in the path of the vagus nerve and recurrent laryngeal nerve, and within the thyroid parenchyma [7]. An exhaustive search of the neck was undertaken, including skeletonization of the carotid artery to the level of the bifurcation, mobilization of the jugular vein, identification of the course of the vagus nerve through the neck, dissection down to the cervical fascia and prevertebral fascia and mobilization of the pharynx and esophagus from the prevertebral fascia At this point, it was thought that the lesion might be in the upper neck. Post-operatively, the patient continued to have elevated serum calcium and PTH and repeat venous sampling study was performed, again confirming positive uptake in the proximal right internal jugular vein.
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